title: The effectiveness of aquatic physical therapy in the treatment of fibromyalgia: a systematic review with meta-analysis.
abstract: OBJECTIVE
  To assess the effectiveness of aquatic physical therapy in the treatment of fibromyalgia.
  
  
  METHODS
  The search strategy was undertaken using the following databases, from 1950 to December 2012: MEDLINE, EMBASE, CINAHL, LILACS, SCIELO, WEB OF SCIENCE, SCOPUS, SPORTDiscus, Cochrane Library Controlled Trials Register, Cochrane Disease Group Trials Register, PEDro and DARE.
  
  
  METHODS
  The studies were separated into groups: Group I - aquatic physical therapy × no treatment, Group II - aquatic physical therapy × land-based exercises and Group III - aquatic physical therapy × other treatments.
  
  
  RESULTS
  Seventy-two abstracts were found, 27 of which met the inclusion criteria. For the functional ability (Fibromyalgia Impact Questionnaire), three studies were considered with a treatment time of more than 20 weeks and a mean difference (MD) of -1.35 [-2.04; -0.67], P = 0.0001 was found in favour of the aquatic physical therapy group versus no treatment. The same results were identified for stiffness and the 6-minute walk test where two studies were pooled with an MD of -1.58 [-2.58; -0.58], P = 0.002 and 43.5 (metres) [3.8; 83.2], P = 0.03, respectively.
  
  
  CONCLUSIONS
  Three meta-analyses showed statistically significant results in favour of the aquatic physical therapy (Fibromyalgia Impact Questionnaire, stiffness and the 6-minute walk test) during a period of longer than 20 weeks. Due to the low methodological rigor, the results were insufficient to demonstrate statistical and clinical differences in most of the outcomes.
authors.affiliation: PAIFIT Research Group, Universidade Estadual de Londrina, Brazil.
authors.forename: Tarcisio Brandão
authors.initials: TB
authors.lastname: Lima
authors.forename: Josilainne Marcelino
authors.initials: JM
authors.lastname: Dias
authors.forename: Bruno Fles
authors.initials: BF
authors.lastname: Mazuquin
authors.forename: Carla Tassiana
authors.initials: CT
authors.lastname: da Silva
authors.forename: Regiane Mazzarioli Pereira
authors.initials: RM
authors.lastname: Nogueira
authors.forename: Amélia Pasqual
authors.initials: AP
authors.lastname: Marques
authors.forename: Edson Lopes
authors.initials: EL
authors.lastname: Lavado
authors.forename: Jefferson Rosa
authors.initials: JR
authors.lastname: Cardoso
mesh_terms: D016206:Databases, Bibliographic; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005356:Fibromyalgia / Q000628:therapy*; D006801:Humans; D008297:Male; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D013550:Swimming / Q000502:physiology*
keywords: Fibromyalgia; aquatic physical therapy; controlled clinical trial; hydrotherapy; meta-analysis